Immune checkpoint inhibitors

(e.g., nivolumab, pembrolizumab, cemiplimab, avelumab, atezolizumab, durvalumab, ipilimumab, tremelimumab)

Strategy 1

Strategy 2

ECG AND Troponin*

before cancer treatment begins

ECG AND Troponin*

within 48h before each administration AND if other irAEs

Check new cardiovascular symptoms/signs

before each administration

ECG AND Troponin

if other irAEs

New cardiovascular symptoms/signs OR

Troponin+ OR

ECG abnormality

Suspect myocarditis

Hold cancer treatment

Refer to a cardio-oncology unit for monitoring and diagnostic work-up

*Assays should be carried out by the same laboratory (same type of troponin, same method of measurement).

Troponin + if >99e percentile of the URL

irAEs=immune-related adverse events

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University Mediterranean Center of Cardio-Oncology

North Hospital, chemin des Bourrely, 13015 Marseille, France

Aix-Marseille University

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© 2020 by Franck Thuny